A pharmacist describes a personal nightmare that began when his elderly mother-in-law was hospitalised
Does your contact with any of your elderly patients extend into their homes? Do you deliver medicines to any such patients? Perhaps you make up Nomad trays for them. Particularly if these elderly patients are members of your family, you face extraordinary risks because you are a pharmacist.
My wife Lesley and I regard ourselves as perfectly ordinary pharmacists. Nearly 10 years ago, we came home again to North Wales to be near our roots and our families. We still work a full week between us - a very civilised arrangement. Lesley's mum (I shall call her "Gran") is now 101 years old, still insisting on living by herself, 10 minutes drive away, across the valley. On her way home from work, Lesley would invariably visit her mum with shopping, chat and a good supply of TLC.
Gran is remarkably fit. She robustly defends her independence and caters for almost all of her own needs, fiercely dismissing suggestions of "help" or "assistance". She can be quite stubborn and we have had our moments of apprehension in concern for her welfare. She would tell you with pride that her two daughters are pharmacists.
Lesley would collect the regular prescription from the surgery every month and dispense it herself. This modestly comprised allopurinol 200mg mane, omeprazole 20mg mane and betahistine 8mg mane.
In February last year, Gran was admitted to hospital after a suspected transient ischaemic attack (TIA). She was, however, quickly diagnosed as suffering from hypoglycaemia. This was corrected with intravenous glucose and she was home after a week. The whole episode seemed to be (without wishing to sound dismissive) "fairly straightforward". During Gran's stay at the hospital, Lesley visited her daily and there appeared to be nothing untoward about her condition, her treatment or her recovery. Recover she most certainly did for she looked and sounded well, saying that she had "enjoyed the break".
Several days after Gran had returned home, I received a telephone call from the surgery (where Lesley and I are also registered). One of the more senior partners was telling me that they had received from the hospital a pathology report on what was claimed to be an admission sample of Gran's blood. Could I offer any explanation as to why it should contain 65μg/L of "sulphonyl-urea"? I could not, and I said so. I also quite confidently, and emphatically, said that this was near impossible and, in a friendly manner, I suggested that either the sample, the test itself, or the report of the test was flawed. I suggested that the answer to any such puzzle must rest with the originator of the report and that this should be said to the hospital. We also were understandably puzzled, but we were not alarmed. We were quite sure that a sulphonylurea preparation could neither have been present among Gran's medication nor that any would have passed Gran's eagle-eyed scrutiny of all that she ingested. Furthermore, our detailed and intimate knowledge of the chronology of events leading up to Gran's admission, together with a fair grasp of the pharmacokinetics of sulphonylureas, were evidence enough for us both to be quite sure that this was nigh impossible. We were confident that an explanation would be found.
We were wrong. The surgery informed the police and over the course of the next two weeks Gran received four or five visits from them. None of these visits was announced, no appointments were made and she was to undergo a total of more than 12 hours of questioning, generally alone and unaided. She became confused, worried and frightened, as might be expected of someone of her age. Lesley and I were interviewed. Lesley's pharmacist sister asked the police to show Gran great courtesy. I complained to the chief constable about the way that the inquiry was being conducted.
Then, one morning, at around 8am, six police officers with a search warrant broke into our home and arrested Lesley and me on suspicion of attempted murder. When we had dressed we were separated, driven to a police station and locked away in our cells. It took over eight hours for me to locate and engage a suitable local solicitor. We separately provided comprehensive, recorded interviews wherein we were both able to satisfactorily answer each and every question put to us. At 4am the following morning Lesley was charged with administering a noxious substance to her mother, an indictable offence carrying a maximum penalty of six years' imprisonment. She was locked away again until she was escorted to the court building, in handcuffs, the following day. I was released into the night.
In the magistrates' court the following afternoon the lawyer acting for the Crown Prosecution Service made statements about the prevailing circumstances and, more particularly, about the blood sample involved that were, in the light of events, questionable. The prosecution, in what used to be termed as "applying for committal" (to a higher court), were making a very strong case for Lesley to be remanded in custody. The information made available to our lawyer and me appeared to be sparse, disjointed and incomplete. Some of it we found incomprehensible. I am still convinced that only by the informed advocacy of our solicitor, supported by our offering of a ridiculously large sum in bail, were we able to secure Lesley's release from custody. One of the conditions of bail was to result in Lesley's complete and utter separation from her mother for over three months.
The following months were the most harrowing period of our lives and I shall refrain from making any attempt to describe here the sheer awfulness of them all. We considered it necessary to engage the services of an international firm of lawyers before we set about the complicated and demanding task of establishing Lesley's complete innocence. We thought this might only be possible by our determining what, in truth, really happened to Gran.
Over this period we amassed a small library of technical information, ranging from that detailing the use of herbicidal sulphonylureas to the results of research on the influence of post cerebral ischaemia upon insulin mechanisms in the pancreas. The services of Dr Robin Ferner, as a world expert on the pharmacokinetics of sulphonylureas, and of Professor Robert Forrest, as a leading forensic pathologist, were to prove invaluable to us. My colleagues subscribing to the Private-Rx pharmacy forum on the internet were more than generous with their time and they greatly assisted with our global searches of medical and technical literature. Anthony Barnfather, of the Pannone legal partnership, employed an awesome legal expertise in dealing with the Crown Prosecution Service. It was his unwavering dedication that was eventually to persuade the service, early in June, 1999, that its evidence was unsustainable and it consequently notified Lesley that the case had been "discontinued". This advance was of little comfort, for the letter read: "The decision to discontinue these charge(s) has been taken because at the present time there is not enough evidence to provide a realistic prospect of conviction, but please note it is anticipated further evidence may become available in the future, as a result of which the prosecution may be recommenced."
The reference to "further evidence" was the expected outcome of a gas chromatography-mass spectrometry (GC-MS) assay proposed for a small remaining sample of blood. It was to be a further six months before this assay was performed. Before that was to happen, and unbeknown to us, a urine sample had been subjected to the same radioimmunoassay procedure that had produced the original report. We were told that this also had indicated a "trace of sulphonylurea". We now know for certain that the reliability of that assay has become highly suspect, for there was no sulphonylurea in either the urine sample or the blood sample.
The GC-MS assay was conducted very recently by the Metropolitan Police forensic science laboratory, and it showed that none of the suspected sulphonylureas was present at all. Lesley has now been left with a brief letter from the Crown Prosecution Service saying quite bluntly and without apology that "there will be no prosecution". Both we and our entire family are now, presumably, to be left in peace and allowed to set about repairing our lives.
A week after we were arrested a short report appeared in this Journal that also detailed Lesley's entry in the register under her maiden name (Sistern) and which named me as her husband. This was more bruising to Lesley's soul than the hurtful whole-page headlines of the press. She was mortified to have received such publicity with no immediate opportunity of response. This sparse, factual account that I am making here is a signal tribute to her dignity under extreme pressure, a salute to her courage and resolve. She would also wish it to be read as a warning to her colleagues. This could happen to any one of us caring for an elderly relative or home-bound patient - simply because we are pharmacists.
Mr Hughes is a community pharmacist living in North Wales